'Signals are good' ahead of Gavi replenishment, CEO says

DAVOS, Switzerland — The team from Gavi celebrated the vaccine alliance’s 20th anniversary and made the case for its upcoming replenishment at the World Economic Forum Annual Meeting this week.

Gavi was founded in Davos two decades ago and is hailed as one of the gathering’s brightest examples of success. Today, it buys vaccines for nearly 50% of the world’s children. The alliance’s ability to create a marketplace with long-term predictability, which makes it possible for companies to invest in vaccines, is what made it successful, said Gavi CEO Seth Berkley.

Gavi is trying to raise $7.4 billion to support its work from 2021-25, and the “signals are good” thus far in the run-up to the June 4 replenishment conference, Berkley said.

“But of course, it is an uncertain time in the world, and there are many priorities,” he said, adding that Gavi has to ensure that there is a critical mass of people advocating for the organization.

Moving forward, Gavi’s strategy will focus on what the alliance refers to as “zero-dose communities,” or the 10% of children globally who don’t have access to routine vaccinations.

“What we would like to do is focus in on leaving no one behind … and try to help governments bring vaccines to them to start with,” Berkley said, referring to such children “But of course, vaccines don't deliver themselves. So it [Gavi’s strategy] brings health workers, it brings data systems that bring supply chains. And that's a way to build universality in health care.”

Gavi has traditionally worked in low-income countries, but it is exploring a strategy for working in middle-income countries, where 70% of the underimmunized children will be by 2030. Gavi is considering working with the lower end of middle-income countries to help them procure vaccines at more affordable prices, but the trick will be finding a price where the industry sees it as profitable and countries say they want to roll out the vaccine programs, he said.

There are also about 10 million children who are underimmunized, according to Berkley, and Gavi must work to boost confidence in vaccines and ensure that families have access. That “last mile” is no longer just rural children, but it’s those living in urban slums or those who have been forced to migrate, he said.

Governments have sometimes called for Gavi to provide more flexible support in the form of cash that would allow them to invest in health systems. This is something the alliance has done and will continue to do, although it depends partly on the replenishment, Berkley said.

“Of course we can't finance the entire health system. What we can do is give catalytic funding that then can be followed by funding from the countries,” he said.

Gavi has faced some criticism from organizations, such as Médecins Sans Frontières, who say that the alliance should look beyond giant pharmaceutical companies to secure the best prices, particularly when it comes to the pneumonia vaccines.

Until recently, the only pneumonia vaccines were available from GlaxoSmithKline and Pfizer, and Gavi was buying them for much less than their prices in the West, Berkley said. Gavi currently pays about $9 a dose, but a new Indian manufacturer has emerged and may sell its vaccine at a lower price, he said.

MSF reports that the new vaccine is expected to cost 30% less than the ones provided by GSK and Pfizer.

“What we ultimately want is a healthy, competitive marketplace that will allow us to make sure there’s supply security and the best pricing as possible,” Berkley said.

As Gavi plans for the future, it is looking at how to support and distribute potential new vaccines for tuberculosis, malaria, and perhaps even HIV, if such a vaccine is developed. But the alliance is also taking a wider view and looking to help harness intellectual power and technologies to narrow the gap to meeting the Sustainable Development Goals.

“If we [just] do things like reach every child with immunization, leave no one behind, of course we won't be happy with that. But that means there's a health worker, there's a system, there's supply chain, and therefore, you can tag other things onto it,” Berkley said.